Outcome of traumatic thoracolumbar spine fractures in elderly: A systematic review

Introduction

Adequate guidelines for treatment of people over 65 years, suffering traumatic thoracolumbar spine fractures without neurologic deficit, are currently lacking.

Research question

The aim of this study was to systematically review the available literature regarding the outcome of conservative and surgical treatment of thoracolumbar spinal trauma in elderly patients.

Material and methods

A systematic review according the PRISMA guidelines was performed. Pubmed, Web of Science, EMBASE and the Cochrane Central register were searched until June 2021. Risk of bias of the included studies was evaluated. Clinical and radiological results, as well as complications of conservative or surgical treatment were reviewed.

Results

Six articles were included (one prospective randomized trial, two prospective and three retrospective cohort studies). In these studies conflicting results were observed with regard to pain, radiological results and complications following both conservative and surgical treatment strategies for thoracolumbar spine fractures in elderly.

Discussion and conclusion

Treatment of thoracolumbar fractures in elderly should focus on early mobilization to reduce complications and hospital stay. This may improve functional outcome and prevent worsening of frailty in this vulnerable group of patients. To elucidate the optimal treatment for elderly patient with thoracolumbar fractures, future research should focus on patient specific treatment rather than the mere difference between outcome of surgical and conservative treatment.

Objective sleep patterns and validity of self-reported sleep monitoring across different playing levels in rugby union

Background

Growing evidence highlights that elite rugby union players experience poor sleep quality and quantity which can be detrimental for performance.

Objectives

This study aimed to i) compare objective sleep measures of rugby union players between age categories over a one week period, and ii) compare self-reported measures of sleep to wristwatch actigraphy as the criterion.

Methods

Two hundred and fifty-three nights of sleep were recorded from 38 players representing four different age groups (i.e. under 16, under 18, senior academy, elite senior) in a professional rugby union club in the United Kingdom (UK). Linear mixed models and magnitude-based decisions were used for analysis.

Results

The analysis of sleep schedules showed that U16 players went to bed and woke up later than their older counterparts (small differences). In general, players obtained seven hours of sleep per night, with trivial or unclear differences between age groups. The validity analysis highlighted a large relationship between objective and subjective sleep measures for bedtime (r = 0.56 [0.48 to 0.63]), and get up time (r = 0.70 [0.63 to 0.75]). A large standardised typical error (1.50 [1.23 to 1.88]) was observed for total sleep time.

Conclusion

This study highlights that differences exist in sleep schedules between rugby union players in different age categories that should be considered when planning training. Additionally, self-reported measures overestimated sleep parameters. Coaches should consider these results to optimise sleep habits of their players and should be careful with self-reported sleep measures.

A review of the biomechanical determinants of rugby scrummaging performance

Background

The scrum is a physical contest unique to the game of rugby union, important for determining match outcomes.

Objective

This review will describe the current understanding of the kinetic and kinematic determinants of successful scrum performance to support coaching interventions and inform on future research.

Methods

Literature review.

Results

Individual and combined scrumming forces increase with playing level but there is no concurrent increase in body mass or player strength. There is very little variation in individual kinematics between individuals and across levels of play, suggesting that there are limited possible techniques for successful scrummaging. Live scrum contests are dynamic and require constant adjustments to body positions in response to increased compressive force and exaggerated lateral and vertical force components. Skilled performers are able to exert high levels of horizontal force while maintaining effective body positions within this dynamic environment.

Conclusion

Success in scrummaging depends on the optimisation of joint angles and force production at the individual level, and the coordination of effort at a team level. The analysis presented here demonstrates that producing large scrum-specific forces and achieving the optimal 'body shape' are essential for successful scrum performance.

Injury incidence and characteristics in South African school first team rugby: A case study

Background: Despite its apparent popularity, participation in the sport of rugby union is accompanied by a significant risk of injury. Concerned parties have recently questioned whether this risk is acceptable within school populations. This is difficult to assess within the South African schools’ population as no recent longitudinal injury studies exist.Objectives: To determine the training habits, rugby-related exposure and injury risk within a population of South African high school first team rugby players.Methods: Training and match exposure in both school and provincial competition were examined and the resultant injuries were longitudinally observed for the duration of a South African high school rugby season.Results: Match (79, 95%CI 52-105 injuries/1 000 h) and training (7, 95%CI 3-11 injuries /1000h) injury incidences were demonstrated to be greater than previously reported incidences in similar populations in England and Ireland. Weeks where players were exposed to both school and provincial competition (34, 95%CI 19-49 injuries /1 000 h) had significantly (p<0.05) greater injury incidences than during school competition alone (19, 95%CI 12-26 injuries /1 000 h).Conclusion: The injury risk demonstrated was greater than expected and represents reasons for concern. Possible reasons for the high injury incidence recorded may be the frequency of games played within the season, and the overlap of school and provincial competitions. It should be noted that these results were taken from one school over one season and might not be representative of the incidence of school rugby injuries overall. However, this research demonstrates the need for a multischool longitudinal study within South African schools rugby to determine the overall risk.

Glypican-3 modulates BMP- and FGF-mediated effects during renal branching morphogenesis

The kidney of the Gpc3-/ mouse, a novel model of human renal dysplasia, is characterized by selective degeneration of medullary collecting ducts preceded by enhanced cell proliferation and overgrowth during branching morphogenesis. Here, we identify cellular and molecular mechanisms underlying this renal dysplasia. Glypican-3 (GPC3) deficiency was associated with abnormal and contrasting rates of proliferation and apoptosis in cortical (CCD) and medullary collecting duct (MCD) cells. In CCD, cell proliferation was increased threefold. In MCD, apoptosis was increased 16-fold. Expression of Gpc3 mRNA in ureteric bud and collecting duct cells suggested that GPC3 can exert direct effects in these cells. Indeed, GPC3 deficiency abrogated the inhibitory activity of BMP2 on branch formation in embryonic kidney explants, converted BMP7-dependent inhibition to stimulation, and enhanced the stimulatory effects of KGF. Similar comparative differences were found in collecting duct cell lines derived from GPC3-deficient and wild type mice and induced to form tubular progenitors in vitro, suggesting that GPC3 directly controls collecting duct cell responses. We propose that GPC3 modulates the actions of stimulatory and inhibitory growth factors during branching morphogenesis.